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Hepatitis A

Outbreak

Outbreak of Hepatitis A in North Carolina

Multiple states have reported large outbreaks of hepatitis A associated with person-to-person transmission. Cases have occurred primarily among three risk groups: (1) persons who use injection or non-injection drugs; (2) persons who are experiencing homelessness; and (3) men who have sex with men. North Carolina is experiencing an outbreak of hepatitis A as described below, though not of the same magnitude as some other states.

Hepatitis A can be prevented by a safe and effective vaccine.  If you are in one of the risk groups described (a person experiencing homelessness, a person who uses injection or non-injection drugs, or a man who has sex with men) or if you had contact with someone with hepatitis A, contact your health care provider or local health department about hepatitis A vaccine.

Additionally, always wash your hands with soap and water after going to the bathroom, after changing diapers, and before preparing meals for yourself and others.

North Carolina Hepatitis A Outbreak-associated Cases, April 1, 2018 - June 9, 2021

Cases Hospitalizations Deaths
855 535 (62.6%) 13 (1.5%)
County Cases
Rate per 100,000
Population
Alamance 4
2.4
Alexander 7
18.7
Ashe 5
18.4
Bladen 1
3.1
Brunswick 7
4.9
Buncombe 41
15.7
Burke 59
65.2
Cabarrus 17
7.9
Caldwell 38
46.2
Carteret 1
1.4
Catawba 67
42.0
Chatham 3
4.0
Cherokee 13
45.4
Clay 1
8.9
Cleveland 24
24.5
Columbus 2
3.6
Craven 2
2.0
Cumberland 1
0.3
Davidson 61
36.4
Davie 1
2.3
Durham 8
2.5
Forsyth 60
15.4
Franklin 1
1.4
Gaston 78
34.7
Gates 1
8.6
Graham 2
23.7
Guilford 16
3.0
Harnett 4
2.9
Haywood 5
8.0
Henderson 16
13.6
Iredell 7
3.9
Johnston 3
1.4
Lee 3
4.9
Lincoln 21
24.2
Macon 2
5.6
Madison 2
9.2
McDowell 2
4.4
Mecklenburg 48
4.3
Montgomery 5
18.4
Moore 4
4.0
New Hanover 3
1.3
Onslow 2
1.0
Orange 4
2.7
Polk 4
19.3
Randolph 60
41.8
Richmond 9
20.1
Rockingham 3
3.3
Rowan 34
23.9
Rutherford 3
4.5
Stokes 17
37.3
Surry 22
30.6
Swain 1
7.0
Transylvania 7
20.4
Union 2
0.8
Wake 16
1.4
Watauga 2
3.6
Wayne 6
4.9
Wilkes 16
23.4
Yadkin 1
2.7
TOTAL 855
8.2

Figure 1: Confirmed outbreak-associated cases of hepatitis A in North Carolina, county map: January 01, 2018 – May 12, 2021 (n=777)Map of Hepatitis A Cases

Figure 2:Confirmed outbreak-associated rates of hepatitis A in North Carolina, county map: January 01, 2018 – May 12, 2021 (n=777)Map of Hepatitis A Rates per 100,000 Population

Case Definition

Clinical Description

An acute illness with a discrete onset of any sign or symptom consistent with acute viral hepatitis (e.g., fever, headache, malaise, anorexia, nausea, vomiting, diarrhea, and abdominal pain), and either a) jaundice, or b) elevated serum alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels.

Case Classification

Confirmed:

  • A case that meets the clinical criteria and is IgM anti-HAV positive*, OR
  • A case that has hepatitis A virus RNA detected by NAAT (such as PCR or genotyping) OR
  • A case that meets the clinical criteria and occurs in a person who had contact (e.g., household or sexual) with a laboratory-confirmed hepatitis a case 15-50 days prior to onset of symptoms

*And not otherwise ruled out by IgM anti-HAV or NAAT for hepatitis A virus testing performed in a public health laboratory

North Carolina Outbreak Case Definition

Outbreak-associated case:

An acute case of hepatitis A meeting the confirmed case classification with onset on or after January 1, 2018 in a North Carolina resident who:

  1. Reports at least one of the following risk factors: homelessness, drug use (injection or non-injection), or MSM status; OR
  2. Has a hepatitis A genotype that matches a genotype predominant in a recent or current US hepatitis A outbreak; OR
  3. Is epidemiologically linked to a person meeting one of the above criteria.

 

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